<%@ page language="java" contentType="text/html; charset=UTF-8"
	pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>

<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>发放就诊卡</title>
<link type="text/css" rel="stylesheet"
	href="${pageContext.request.contextPath }/assets/fontsawesome/css/font-awesome.css" />
<link type="text/css" rel="stylesheet"
	href="${pageContext.request.contextPath }/assets/css/style.css" />
<link type="text/css" rel="stylesheet"
	href="${pageContext.request.contextPath }/assets/css/datepicker.css" />
</head>
<body>
	<style>
.tip {
	width: 100%;
	padding: 2em 0;
	text-align: center;
	background-color: #34AB4C;
	color: white;
	font-weight: bold;
	margin: 1em 0;
	border-radius: 5px;
}
</style>

	<c:if test="${medicalId != null }">
		<div class="tip">发卡成功！就诊卡编号为：&nbsp;&nbsp;&nbsp;&nbsp;
			${medicalId }</div>
	</c:if>


	<div class="main_box">
		<h2>
			<span></span>发放就诊卡
		</h2>
		<div class="cont_box">
			<form action="${pageContext.request.contextPath }/patientService.do"
				method="post" id="user_form">
				<input type="hidden" name="method" value="faka">
				<ul class="addpro_box adduser_box">
					<li><label>姓名：</label> <input type="text" placeholder="请输入姓名"
						name="medicalName" required data-rule-mobile="true"
						data-msg-required="姓名不能为空" /></li>
					<li><label>性别：</label>
						<ul class="pay_box clearfix">
							<li class="radio_box"><input type="radio"
								name="medicalGender" value="male" id="11" checked="checked" /> <span
								id="member">男</span></li>
							<li class="radio_box"><input type="radio"
								name="medicalGender" value="female" id="22" /> <span>女</span></li>
						</ul></li>
					<li><label>身份证号：</label> <input type="text"
						placeholder="请输入身份证号" name="medicalIdcard" required
						data-rule-mileage="true" data-msg-required="身份证号不能为空" /></li>
					<li><label>手机号：</label> <input type="text"
						placeholder="请输入手机号" name="medicalPhone" required
						data-rule-mileage="true" data-msg-required="手机号不能为空" /></li>
				</ul>
				<div class="probtn_box clearfix">
					<input type="submit" value="发放就诊卡" class="btn blue_btn" />
				</div>
			</form>
		</div>
	</div>

</body>
</html>